IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2004 | Volume:5 | Issue:Supplement (4)|Papers Count:14

Introduction: The role of gene and environment in the pathogenesis of abnormal lipid profile is still the case of controversy. To clarify the importance of certain parental risk factors associated with the lipid profiles of children and adolescents, we conducted this cross-sectional population based study in district-13 in the east of metropolitan Tehran.Materials and Methods: One hundred thirteen eligible families comprising 455 subjects (including 229 offspring aged 5-25 years) were enrolled into the study. Anthropometric data were measured by a standard protocol. For the measurement of lipid profiles, venous blood was obtained in the morning, after the subjects had fasted 12-14 hours overnight. Dietary intakes were assessed by means of a two-day dietary recall questionnaire.Results: The chances of having elevated serum total cholesterol (TC) were higher in sons of fathers with high cholesterol intake (OR=3.1; CI=1.1-9.2) and mothers with high saturated fatty acids (SFA) intake (OR=3.4; CI=1.1-1 0.8). Positive correlation was seen between energy intake of fathers and serum TC of their daughters (r=0.34, p<0.01), between SFA intake of fathers and serum trigelycerides (TGs) of their sons (r=0.29, p<0.01) and between mothers body mass index (BMI) and daughter's serum TGs (r=0.23, p<0.03). The chances of having low serum high-density lipoprotein- cholesterol (HDL-C) were lower in sons of mothers with high carbohydrate intake (OR=11.0; CI=2.8-42.8) and mothers with high serum HDL-C (OR=6.8; CI=1.7-27.0). The chances of having elevated serum low-density lipoprotein-cholesterol (LDL-C) were higher in sons of fathers with high SFA intake (OR=4.5; CI=1.4-14.3); and sons of mothers with high serum TGs (OR=6.1; 1.3- 29.0) and of mothers with high cholesterol intake (OR=4.3; CI=1.2-15.2).Conclusion: The results indicate independent associations between diet contents, the lipid profiles of parents and those of their offspring as well as between lipid profiles and diet contents among spouses.

Introduction: There is an association between the common CETP polymorphism, Taql in intron 1, with HDL level in some populations. We studied this association because of low levels of high density lipoprotein in Iranian population.Materials and Methods: To examine the relation between Taql polymorphism and high density lipoprotein level, 1021 people from TLGS in Tehran (467 men and 554 women) were selected. We measured HDL-C, triglycerides and cholesterol level and accounted for factors that are known to influence HDL cholesterol level, such as smoking, body mass index and blood pressure. We amplified a segment of mentioned gene with PCR and then revealed the polymorphism with RFLP. Result: The B2 (cutting site absent) allele frequency was 0.378 in men and O. 386 in women, and its presence, was significantly associated with increased levels of HDL-C (8181, 1.0±0.2 mmol/L; 8282, 1.19±0.31 mmol/L; P<0.001) in the whole population, but no significant relationship was observed in men. This genetic variation was independent of metabolic risk factors known to influence HDL levels. Conclusion: These data demonstrate that variation at the CETP gene locus is a significant determinant of HDL-C level in this population

Introduction: Several studies have demonstrated that aspirin therapy can be used as primary and especially secondary prevention of cardiovascular disease (CVD) in people with diabetes. Since 1997, American Diabetes Association has recommended aspirin therapy for adults with diabetes who have CVD or CVD risk factors. In this study, we examined the prevalence of aspirin use among adults with diabetes in an Iranian population.Materials and Methods: 623 urban adults with self-reported diabetes and fasting blood glucose ≥126 mg/dL or antidiabetic drug use were selected from adult population aged ≥21 years in the cross-sectional phase of Tehran Lipid and Glucose Study (TLGS) which is a longitudinal study on CVD risk factors in east of Tehran. In the study after a cluster random sampling, individuals were invited to TLGS center and a complete medical history record, physical examination, anthropometric and laboratory studies (with fasting blood sample) were done. CVD conditions were self-reported history of coronary heart disease and stroke and symptoms of angina and claudication according to Rose questionnaire. CVD risk factors included smoking, hypertension, obesity, lipid abnormalities and family history of CVD.Results: An estimated 26% of adults with diabetes had CVD and ≥99% of others had one or more CVD risk factors. Aspirin was used regularly by 34.6% of diabetics with CVD and by 9.8% of those with risk factors. 16.3% (95% CI: 13.4%-19.2%) of all diabetics took aspirin regularly. In a logistic regression model, adjusted odds ratio of regular aspirin use was significantly greater for individuals with CVD than for those with 0-1 CVD risk factors (OR= 4.9; 95% CI: 2.3-10.6) ; for individuals older than 50 years than for those below 50 (OR= 2.1; 95% CI: 1.1-4.3) and for men than women (OR= 1.6; 95% CI: 1.02-2.56).Conclusions: Almost every adult in Tehran with diabetes has CVD or at least one risk factor for CVD and thereby may be considered a potential candidate for aspirin therapy. According to estimated low prevalence of regular aspirin use, major efforts are needed to increase it and prevent CVD in diabetic patients.

Introduction: The purpose of this study was to report the prevalences of thinness, overweight and obesity among an urban population of Tehran adolescents aged 10-19 years based on a good obesity standard.Materials and Methods: This was a cross-sectional survey among inhabitants of district-13 in the east of Tehran. A total of 3265 adolescents including 1541 boys and 1724 girls were included. Weight and height were measured using a standard protocol and body mass index (kg/m2 was calculated. The criteria used to define body composition were based on BMI cut-off points of the WHO Expert Committee.Results: The overall relative frequency of thin adolescents was 10.9% (CI: 9.8-12.0) ; 13.0% (CI: 11.3-14.7) in boys vs. 9.0% (CI: 7.6-10.4) in girls (p<0.001). Overweight was seen in 12.6% (CI: 11.5-13.7) of adolescents; 11.8% (CI: 10.2-13.4) in boys vs. 13.3% (CI: 11.7-14.9) in girls (non-significant). Obesity was seen in 5.4% (CI: 4.6-6.2) of Tehran adolescents; 6.9% (CI: 5.6-8.2) in boys vs. 4.0% (CI: 3.1-4.9) in girls, p<0.001.Conclusion: As a developing country passing through nutritional transition, both the problems of thinness and obesity are prevalent in Tehran(s) urban adolescents.

Introduction: Obesity is one of the major health problems which has increased in prevalence since the beginning of 20th century. This study was conducted to measure the prevalence of obesity in adults residing in distinct-13 of Tehran in 1999-2000 and to examine the associations of obesity with some factors.Materials and Methods: A total 9984 subjects (4164 men and 5820 women) aged 20-70 years among who participated in Tehran Lipid and Glucose Study, chosen by multistage cluster random sampling, were assessed. Demographic data were collected and anthropometric indices include weight, height, waist and hip circumference were measured according to standard protocols. Overweight was defined, as body mass index=25-29.9 and obesity was defined as body mass index ≥30. Prevalence of obesity and central obesity was determined as the percentage in each age and sex separately. To determine the associations between obesity and other factors logistic regression was used.Results: The mean body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were 25.8±4.1 kg/m2 ,88.3±11.4 cm and 0.91±0.07 in men and 27.3±5.4 kg/m2, 87.5±12.9 cm and 0.83±0.08 in women, respectively. Obesity and central obesity were more prevalent in women than men (29.1% vs 14.2% for obesity; 66.1% vs 32.1% for centeral obesity, respectively). Low education level in women and illiteracy in men, marriage and low physical activity in both sexes were strongly associated with obesity. Conclusions: The prevalence of obesity in Tehran adults was high. Strong associations between obesity and life style factors confirm the relation between physical activity, education and marriage with obesit

Introduction: This study was conducted to assess the relationship between obesity and cardiovascular disease risk factors in the participants of the Tehran Lipid and Glucose Study (TLGS). Material and Methods: From 15005 participants of TLGS, all 8647 subjects aged 20-70 years (3622 males and 5025 females) were included in this study. Anthropometric indices were measured according to standard protocols. BMI and WHR were calculated. Obesity was defined as BMI≥30 kg/m2 and central obesity as WHR≥0.9 for men and ≥0.8 for women. Blood pressure was measured according to standard protocol. Hypertension was defined as SBP≥40 or DBP≥90 mmHg or using antihypertensive drugs. Serum cholesterol, triglyceride and HDL-C were measured by autoanalyzer using commercial kits and LDL-C was calculated. Hypercholesterolemia (TG ≥200 mg/dL) hypertriglyceridemia (TG ≥50 mg/dL) . high LDL-C (≥30 mg/dL) and low HDL-C (<40 mg/dL) were defined according to ATP III.Results: Obese men had higher chance of being hypertensive (OR=2.8, 95%CI=1.9-4.2) and having hypercholesterolemia (OR=1.6, 95%CI=1. 1-2.1), hypertriglyceridemia (OR=1.8, 95% CI=1.3-2.4), high LDL-C (OR=1.4, 95% CI= 1.1-1.9) and low HDLC (OR= 1.7, 95%CI= 1.3-2.4) than normal men. Centrally obese men were more susceptible to hypertriglyceridemia (OR=1.8, 95%CI=1.4-2.3) . hypertension (OR=1.5, 95%CI=1.1-2.0) and hypercholesterolemia (OR=1.3, 95%CI=1.1-1.7) than normal ones. Obese women had higher chance for being hypertensive (OR=2.5, 95%CI=1.8-3.4) and having hypercholesterolemia (OR=1. 7, 95%CI=1.3-2.1) , hypertriglyceridemia (OR=2.6, 95%CI=2.1-3.3) , high LDL-C (OR= 1.4, 95%CI=1.1- 1.8) and low HDL-C (OR=1.9, 95%CI=1.5-2.4) compared to normal ones. Centrally obese women had higher odds for having hypertriglyceridemia (OR=1.8, 95%CI=1.5-2.2) and low HDL-C (OR=1.6, 95%CI=1.3-1.9) than normal females.Conclusion: The results indicate the association of obesity and cardiovascular disease in a developing country and need for the implementation of preventive programs and changes in lifestyle..

Introduction: Obesity and central obesity are the most important predictors of noncommunicable diseases. Based on previous studies, cutoff values for waist circumference can detect both of them. This study was conducted to assess the sensitivity and specificity of recommended cutoff values for waist circumference and to determine the optimal cut-off values to detect obesity and central obesity in an urban population of Tehran. Materials and Methods: From among the 15005 participants of Tehran Lipid and Glucose Study (TLGS) aged 3-70 years, all 4306 men and 5762 women aged 20 years and over were included in this study. Waist and hip circumferences, height and weight were measured and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Waist circumferences equal or over 94 cm in men and equal or over 80 cm in women were considered as waist action level 1 (people whose health risks were increased and should gain no further weight), and equal or over 102 cm in men and equal or over 88 cm in women were considered as waist action level 2 (high risk people that should reduce their weight). Specificity and sensitivity of these waist action levels to detect both overweight (BMI ≥25kg/m2 ) or obesity (BMI ≥30kg/m2 and central obesity (WHR ≥ 0.95 in men and ≥0.80 in women) were calculated. To estimate the optimal cut-off values for waist circumference for detecting both obesity and central obesity, Roc-curve analysis was used. Results: Mean±SD of waist circumferences were 88.5±11.4 and 87. 7±12.9 cm in men and women, respectively (p<0.01). The prevalence of central obesity, based on recommended WHR cut-off values was 33.0% in men and 67.2% in women (p<0.001). The prevalence of overweight in men was 42.6% and in women it was 38.1%, whereas the prevalence of obesity was 14.4% in men, and 29.5% in women. The findings revealed that 33.3"10 of men and 72.7% of women were categorized as waist action level 1 and 11.7% of men and 50.3% of women were grouped as waist action level 2. Specificities of both action levels were above 95%; however, sensitivities of waist action levels 1 and 2 were 55% and 31% in men and 88% and 70% in women, respectively. Optimal cut-off values for waist action levels 1 and were estimated to be 85 and 90 cm for men and 75 and 80 cm for women, respectively.Conclusion: Considering the low sensitivity and specificity of recommended waist action levels to detect both obesity and central obesity in Tehran men, application of these cut-off values for this population may not be suitable and further studies to determine optimum cut-off values are recommended

Introduction: The aim of this study was to determine the knowledge, attitude and practice of adolescent students aged 10-18 studying in guidance and high schools of district 13 of Tehran, about healthy diet. Material and Methods: This study was undertaken on 7669 adolescent students (4070 boys and 3599 girls) of 22 guidance and high schools residing in district 13 of Tehran. A questionnaire whose reliability and validity were assessed according to specialist recommendations and pretest and post-test were used. The maximum score was calculated according to the number of questions in each part. The key questions were determined by factor analysis.Results: The mean age of the adolescents was 14±1 year. Higher percent of girls had good knowledge (82% of girls vs. 75% of boys, P<0.05). Higher percent of boys had good attitude (39% of boys vs. 33% of girls, P<0.05) and good practice (25% of boys vs. 15% of girls, P<0.05). According to the results, 35% of adolescents do not know that sweets increase weight and 65.4% of adolescents do not know that sausage has cholesterol. 28% of adolescents prefer puff consuming to almond and pistachio and 37.5% prefer whole grain biscuits to the creamed wafers. Only 4.5% of students do not consume beverage by foods.Conclusion: According to this study, a low percentage of adolescents have good practice and their attitude and practice is not according to their nutritional knowledge. These results show the necessity of nutrition intervention in adolescents.

Introduction: The purpose of this study was to determine if systolic blood pressure (SBP) value by itself is sufficient for the classification of blood pressure of Tehran adult population based on JNC-VI (Sixth Report of The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure).Materials and Methods: Clinically, SBP and DBP are sometimes in different stages in the same individual and the higher stage is considered to classify blood pressure level. The prevalence of disparate levels of SBP and DBP has come to attention only recently.. Some researchers have reported the importance of SBP, and not DBP, in determining the appropriate classification of hypertension even in those undergoing treatment. Data were collected for 3823 men and 5159 women aged 20-69 years who were not using antihypertensive medication in Tehran Lipid and Glucose Study (TLGS), cross-sectional phase of a large epidemiological study first established in 1999. The study used mean of two separate blood pressure measurements in each individual. High blood pressure was defined according to the highest level of systolic or diastolic blood pressure.Results: In 86.3% of subjects blood pressure stage was determined according to SBP and in 90.0% of them according to DBP. In 77.4% of subjects (75.7% of men and 78.7% of women), SBP determined BP in the same stage as DBP did. The role of SBP was most prominent in age groups 20-29 years and 60-69 years (91.4% and 90.8%, respectively) and the least in age group 40-49 years (80.4% of subjects). DBP had a more prominent role in younger ages and the least significance in older ages.Conclusions: SBP has a more prominent role than DBP in determining blood pressure stage according to JNC-VI only in 60-69 year-old people and the role of DBP is more prominent in other age groups.

Introduction: The purpose of this study was to estimate the current prevalence and distribution of hypertension in Tehran adult population.Materials and Methods: Data were collected for 3343 men and 5148 women aged 20-69 years in Tehran Lipid and Glucose Study (TLGS), which is a cross-sectional phase of a large epidemiological study, first established in 1999. The study used mean of two separate BP measurements in each individual.Results: Twenty-two percent (23% of women vs 20% of men, P=0.01) had hypertension according to "JNC-VII" and "WHO-ISH" criteria. The average SBP, DBP, and pulse pressures of hypertensive participants were 31, 16, and 15 mmHg higher than the corresponding values for normotensives. Thirty-six percent of participants with JNCVII-based hypertension were using antihypertensive medication (23% of men and 43% of women). Of these, 40% (45% of men and 39% of women) had normal BP. Hypertension awareness was 50% in these participants (57% in men vs 37% in women, P<0.001). Data for 3179 men and 4646 women aged 20-69 years with no antihypertensive treatment were used for analysis of BP measures. Of these, 15% (16% of men and 14% of women, P=0.006) had high BP levels according to JNC-VII. Only 49% (47% of men and 51% of women) had normal BP and prevalence of prehypertension was 36% (37% in men and 35% in women). Mean SBP was 117.8±16.6 and 116.4±16.4 mmHg in men and women, respectively (P<0.001). The equivalent values were 77.4±10.7 and 77.3±9.9 mmHg for DBP (P=0.5) and 40.4±12 and 39.1±11.7 mmHg for pulse pressure (P<0.001).Conclusion: A relatively high prevalence of JNC-VII defined hypertension was found in TLGS adult population with 50% undiagnosed and 60% uncontrolled hypertension. These findings emphasize further considerations for detection and better management of hypertension in urban population of Tehran.

Introduction: The administered Rose questionnaire and rest ECG are frequently used to assess the prevalence of coronary heart disease (CHD) in large population-based surveys. It has been shown that cultural variability may have great impacts on the Rose questionnaire performance. The aim of this study was to evaluate the concordance between the Rose questionnaire and the more objective resting ECG in an urban Iranian adult population participating in the Tehran Lipid and Glucose Study (TLGS).Material and Methods: Individuals older than 30 years were included in this study (N=5539, mean age= 46.37:t11.87 years, female to male ratio=1.23). Results: According to ECG findings, the age-adjusted prevalences of probable and possible CHD were 1.1% and 9.3%, respectively. On the other hand, the age-adjusted prevalences of grade-II and grade-I Rose angina were 1.7% and 7.5%, respectively. In the whole population, the observed agreement between ECGdefined CHD (probable or possible) and Rose angina (grade-II or I) was 84.9%, with kappa coefficient of 0.07 (standard error: 0.02). The agreements between positive and negative results, calculated as Ppos and Pneg , were 0.15 and 0.92 , respectively. Though still poor, males showed higher kappa coefficients and Ppos compared to females. The strongest concordance, was observed among 50-59 years old men and diabetic men (kappa=0.20). Conclusion: Rose angina shows a poor concordance with ECG-based coronary heart disease in our study population. However, this is largely due to disagreement between positive results, while the negative results show substantial agreement. Hence, in large population-based surveys, the angina found after Rose questionnaire administration may still need a more objective diagnostic method to verify it.

Introduction: The study aimed at evaluating the readability and efficacy of design of healthrelated newsletters in the reduction of prevalence of non-communicable diseases. Materials and Methods: Of 15005 participants in the Tehran Lipid and Glucose Study (TLGS) , 5633 underwent the interventional program. Of these 300 households were randomly selected for this study. This investigation employed three tools to assess the efficacy of the publications mentioned; a questionnaire, the Maine Area Health Education Center checklist (AHEC) , and the Simple Measure of Gobbledygook (SMOG) readability formula. Three health newsletters were evaluated and the results of AHEC scores were analyzed using the Kruskal-Wallis test.Results: The response rate of the study was 52%, i.e. 154 completed questionnaires were returned from the selected families. 57% of these subjects had educational levels below high school diplomas and 43% were high ,! school graduates or above. No significant difference was seen between the two sexes. Of the population evaluated, 3% were under 10 years of age, 24% were between 11 and 20, and 68% were over 20 years old. Based of AHEC criteria, the efficacy of the educational materials assessed was 77.8%. Characteristics of the AHEC criteria using for the three reading materials were 23/6±3/0, I 23/3±3/2 and 23/3±2/8 respectively. There was no significant difference in the result of the abovementioned factors. The readability score was 9-10. Conclusion: All the three patient education materials assessed were determined to be relatively appropriate with regard to design and readability in the prevention of NCD for the population assessed.